Graphic warnings on cigarettes effective across demographic groups

Quitting smoking is a common New Year's resolution for Americans each year, but research has repeatedly shown it is not an easy task. Some groups, such as racial/ethnic minorities, have an even harder time quitting.

New research suggests hard-hitting graphic tobacco warnings may help smokers of diverse backgrounds who are struggling to quit. A new study by researchers at Legacy® and Harvard School of Public Health provides further evidence that bold pictorial cigarette warning labels that visually depict the health consequences of smoking — such as those required under the 2009 Family Smoking and Prevention Tobacco Control Act — play a life-saving role in highlighting the dangers of smoking and encouraging smokers to quit.

The study is one of the first to examine the effectiveness of pictorial warning labels versus text-only labels across diverse racial/ethnic and socioeconomic groups. Although a growing body of research has shown that disadvantaged groups may differ in their ability to access, process and act on health information, little is known about communication inequalities when it comes to cigarette warning labels.

The study authors note that text-only cigarette warnings have been repeatedly characterized as unlikely to be noticed or have an impact, and cite prior research indicating pictorial warning labels are more effective.

"Interventions that have a positive impact on reducing smoking among the general population have often proven ineffective in reaching disadvantaged groups, worsening tobacco-related health disparities," said Jennifer Cantrell, DrPH, MPA, and Assistant Director for Research and Evaluation at Legacy®, a national public health foundation devoted to reducing tobacco use in the U.S. "It's critical to examine the impact of tobacco policies such as warning labels across demographic groups."

Senior author Vish Viswanath, associate professor of society, human development, and health at Harvard School of Public Health, said, "There is a nagging question whether benefits from social policies accrue equally across ethnic and racial minority and social class groups. The evidence from this paper shows that this new policy of mandated Graphic Health Warnings would benefit all groups. Given the disproportionate burden of tobacco-related disease faced by the poor and minorities, mandating strong pictorial warnings is an effective and efficient way to communicate the risk of tobacco use."

The new study, published January 14, 2013, in the journal PLOS ONE, examined reactions to cigarette warning labels from more than 3,300 smokers. Results show that hard-hitting, pictorial graphic warnings are more effective than text-only versions, with smokers indicating the labels are more impactful, credible, and have a greater effect on their intentions to quit. Moreover, the study found that the stronger impact of pictorial warnings was similar across vulnerable subpopulations, with consistent reactions across race/ethnicity, education, and income.

"The implementation of graphic warning labels appears to be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups," Cantrell said.

"Tobacco use is a social justice issue," added Donna Vallone, PhD, Senior Vice President for Research and Evaluation at Legacy®. "Given that low income and minority communities have higher smoking rates and suffer disproportionately from tobacco's health consequences, studies like this show us that graphic warning labels can help us reach these subgroups in a more effective way, ultimately saving more lives."

Background:

More than 400,000 Americans die each year as a result of tobacco-related diseases, which include heart disease, cancers, emphysema, and stroke.

The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 required new graphic health warnings that depict the negative health consequences of smoking to be placed on cigarette packages and in cigarette advertisements by September 2012. However, the new labels have been blocked by tobacco companies who have challenged the constitutionality of the Act and its provisions.

The study adds to the research on the effectiveness of graphic warning labels on tobacco products, providing evidence that the FDA-approved pictorial warning labels would achieve their desired effect without exacerbating inequalities, thus enhancing the efficiency and cost-effectiveness of warning label policy.

The study will be available on the PLOS ONE website after the embargo lifts: http://dx.plos.org/10.1371/journal. pone.0052206

Support for the study was provided by Legacy.

Legacy helps people live longer, healthier lives by building a world where young people reject tobacco and anyone can quit. Legacy's proven-effective and nationally recognized public education programs include truth®, the national youth smoking prevention campaign that has been cited as contributing to significant declines in youth smoking; EX®, an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; and research initiatives exploring the causes, consequences and approaches to reducing tobacco use. Located in Washington, D.C., the foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry. To learn more about Legacy's life-saving programs, visit www.LegacyForHealth.org.

Follow us on Twitter @legacyforhealth and Facebook www.Facebook.com/Legacy.

Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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